Stigma and HIV/AIDS in South Africa: Exploring Respect and Treatment Adherence

Aims: The purpose of this study is to contribute to the study of the relationships between stigma and HIV/AIDS treatment adherence in South Africa.
Study Design: A mixed method investigation employed cross-sectional exit surveys in four sites in South Africa (N=1200) and in-depth interviews with 15 patients from 2 sites, one urban and one rural.
Place and Duration of Study: This paper is part of a 5 year long study on three forms of treatment for conditions with adverse outcomes, TB, maternal delivery and HIV/AIDS. It took place between 2008 and 2012 in four sites in South Africa, two urban – Soweto and Mitchell’s Plain and two rural – Bushbuckridge and Hlabisa.
Methodology: The mixed method design used clinic-based exit interviews in multiple sites in the four study areas, selection being based on a stratified approach to include clinics with such characteristics as size, patient flow, geographical accessibility. Patients exiting those clinics were randomly selected for inclusion in the study. All participants were required to be 18 years old or over. Qualitative research took place in Soweto and Bushbuckridge only because of resource constraints. A total of 15 people 4 men, 11 women, between the ages of 27 and 59) were interviewed, some twice on the trajectories of their illnesses. Standard analytic packages of SPSS and Atlas-TI were used for analysis.
Results: The interviews established the importance of various forms of stigma in these populations as well as the importance of social and family support. Gaps were identified in the social support system yet there remained a degree of hope and optimism among the patients. In the quantitative analyses, reports of associations are laid out because of the problematic relationship between stigma and adherence noted in the literature. All associations (except for respect from health care providers are significant at 0.05 with wealth associations being highly significant (0.000, 0.003) as are community support measures (0.000, 0.002). The logistic regression results show few significant relationships with only social support (0.000) being significant for missing taking ARV tablets.
Conclusion: The research presented in this paper is largely supportive of other work on stigma as well as on adherence. It puts forward some suggestions, based on associative analyses, on the still perplexing relationship between stigma and adherence.